Alaska Birth Certificate Request Form Instructions

Who may obtain a birth certificate? • Parent(s) listed on the certificate.• Child listed on the certificate (if 14 years old or older) along with a school ID.• Legal Guardian with certified guardianship papers.• Third-Party requests must have a notarized letter of consent for the release of information from

the certificate holder or legal guardian.• Attorneys & Government Agencies must have a letter on their letterhead stating who they

represent and why the record is needed. Must provide supporting documentation.

Accepted forms of ID (must be unexpired): • Driver’s license• State-issued ID card• Passport• Military ID• Tribal/BIA card• If you have none of the above forms of ID, please contact (907) 465-3391 for assistance.

How to submit a request: • Complete this form with payment and a copy of your ID and submit to Vital Records:• *Faxed orders: please call 10 minutes after sending your fax to confirm receipt.

Alaska Vital Records Office - JUNEAUPhysical Address > 5441 Commercial Blvd (zip code: 99801) Mailing Address > PO Box 110675 (zip code: 99811-0675) Juneau, AKOffice Hours: 8:00 am - 5:00 pm (Walk-In Service) Phone: (907) 465-3391FAX: (907) 465-3618* hss.vr.apps@alaska.gov (Email Orders)

Services Cost Add'l Copies*

Certified Copy (Birth, marriage, divorce, death)† $30 $25 Marriage License $60 N/A Marriage License Re-Issue Fee $15 N/A Adoptions, Paternity, or Amendment/Correction (includes new certificate) # $60 N/A Medical Marijuana Card $25 $20 (renewal) Heirloom Birth Certificate $55 $50 Heirloom Marriage Certificate $65 $60 Apostille (in addition to Certified Copy Fee) $12 $2 Expedite Fee (process request within 48 business hours) $11 N/A

*Additional copies are defined as the same record ordered at the same time. Fees are set in accordance with AS 18.50.330. The fees and postage ratesreflected on this form are accurate as of June 2018. Please refer to www.vitalrecords.alaska.gov for the most current fees and postage rates.†NOTE: If the requested record cannot be found, you will be issued a “Record not Found” on certified paper for the same price as the certificate itself.

# For paternity, adoptions and corrections information, contact our Special Services unit (907) 465-1200

Processing times from receipt of request: Please visit our website and select "Frequently Asked Questions": www.vitalrecords.alaska.gov

(Rev. 11/2019)Page 1

Alaska Vital Records Office - ANCHORAGE 3601 C Street, Suite 128 (Frontier Bldg) Anchorage, AK 99503Office Hours: 8:00 am to 4:30 pm (Walk-In Service) Phone: (907) 269-0991

* Expedited requests must be emailed or faxed** Expedited Paternity, Adoptions or Corrections to a Birth Certificate must be mailed or hand-delivered as Original Documents and/or Certified copies of

forms are required. For additional information on how to amend the Birth Certificate, please contact our Special Services Unit at (907) 465-1200.

STATE OF ALASKA BIRTH CERTIFICATE REQUEST FORM

• Please read the instructions on the first page. Incomplete or inaccurate requests or requests that do not include a copy of agovernment-issued ID with a signature below the ID will be returned unprocessed.

• THIS FORM CANNOT BE USED TO CHANGE/AMEND A BIRTH CERTIFICATE. Please contact our Special Services Unit.

Date of Birth: City or Village of Birth:

Mother's FULL name before she was first married:

Father's FULL name:

Purpose of the request:

(Personal Records, Legal Purposes, Inheritance/Estate Settlement, Govt. Assistance/Benefits, Insurance/Pension, Retirement, etc. )

Contact Phone Number:

Shipping Method: (Call our office for shipping rates outside the

U.S)

Credit Card Information (When paying by credit card)

Expiration date:

Name on credit card:

Billing address:

Number:

Cardholder signature REQUIRED(ELECTRONIC/TYPED SIGNATURE NOT ACCEPTED:)

Please enter your mailing address below:

Name:

Street / PO Box:

City, State, Zip

FULL First/Middle/Last Name on the Birth Certificate:

Rie Muñoz, “The Embrace”

Jon Van Zyle, “Polar Bears”*Expedited/Rush Service (Fax/Email Orders) - ($11.00)*If Birth is already registered; Registration process or records withadministrative holds cannot be rushed

*Does not include shipping fees

Birth Certificates ($30 one copy; $25 each additional copy of the same record ordered at the same time.)

Paternity, Correction, Adoption or Legal Name Change Processing Fee ($30)

Apostille fee ($12 for first copy, $2 each additional copy)

Apostille Country:

Heirloom Certificates ($55 first copy; $50 each additional copy) Heirloom Certificate (select one)

# Copies Amount

HAVE YOU INCLUDED?

Copy of ID

Payment

Other documentation (please list if applicable)

(Rev. 11/2019)

JUNEAU – Vital Records Office(mail) PO Box 110675 (zip code: 99811-0675)

(walk-in) 5441 Commercial Blvd (zip code: 99801) Juneau, AK

Phone: (907) 465-3391 / Fax: (907) 465-3618 Walk-Ins / Mail / Email / On-line

(See back of Form for details)

ANCHORAGE – Vital Records Office3601 C Street, Suite 128 (Frontier Bldg)

Anchorage, AK 99503Phone: (907) 269-0991

Walk-Ins / Mail

In Person: Cash / Check / Money Order / Credit Card By Mail: Check / Money Order / Credit CardBy Fax: Credit Card$30 NSF Fee – for returned checks.Checks/MO payable to: Alaska Vital Records Office

Page 2

Your Relationship to the Child Named on the Record:

Signature of the Person Requesting the Record (ELECTRONIC/TYPED SIGNATURE NOT ACCEPTED):

Regular Mail (No Tracking Available) (No tracking for your sensitive documents. If documents are lost in the mail, you will need to resubmit your order with ID & Payment)Priority Mail (Add $8.00)Express Mail (Add $26.00) FedEx (No P.O. Box / Add $24.25)

TOTAL

No fee

Visa

Mastercard

Discover

American Express

Submit this form with PAYMENT:

Self Mother Father Legal Rep Other:

/ /

Tracking available for Priority, Express and FedEx. Orders shipped with tracking are insured for

replacement if lost (recommended)